Provider Demographics
NPI:1356554737
Name:OMANA, TEODORA
Entity type:Individual
Prefix:
First Name:TEODORA
Middle Name:
Last Name:OMANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 ROBINWOOD RD APT I
Mailing Address - Street 2:HUDSON WOODS APARTMENTS
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1642
Mailing Address - Country:US
Mailing Address - Phone:704-678-4029
Mailing Address - Fax:
Practice Address - Street 1:1926 ROBINWOOD RD APT I
Practice Address - Street 2:HUDSON WOODS APARTMENTS
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1642
Practice Address - Country:US
Practice Address - Phone:704-678-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist